December 22, 2017
Z.M.S. & Y Acupuncture, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 51861(U))
https://www.beynensonlaw.com/case-law/z-m-s-y-acupuncture-p-c-v-geico-gen-ins-co-2017-ny-slip-op51861u/
- Court
- Appellate Term, Second Department
- Decided
- December 22, 2017
- Citation
- 2017 NY Slip Op 51861(U) · 58 Misc 3d 140(A)
- Posture
- Summary judgment
- Outcome
- Split result
- Issues
- Fee schedule
- Legal questions
- Proving a fee schedule defense (see the maps)
Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.
Summary
Editorial summary by Beynenson Law, not part of the court’s decision.
Reported in New York Official Reports at Z.M.S. & Y Acupuncture, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 51861(U))
| Z.M.S. & Y Acupuncture, P.C. v GEICO Gen. Ins. Co. |
| 2017 NY Slip Op 51861(U) [58 Misc 3d 140(A)] |
| Decided on December 22, 2017 |
| Appellate Term, Second Department |
| Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. |
| This opinion is uncorrected and will not be published in the printed Official Reports. |
Decided on December 22, 2017
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th
JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN M.
SOLOMON, JJ
2015-402 K C
against
GEICO General Insurance Company, Appellant.
The Law Office of Printz & Goldstein (Lawrence J. Chanice, Esq.), for appellant. Law Office Emilia I. Rutigliano, P.C., for respondent (no brief filed).
Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered December 17, 2014. The order, insofar as appealed from and as limited by the brief, denied the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services billed under CPT codes 97810, 97811, 97813 and 97814.
ORDERED that the order, insofar as appealed from, is modified by providing that the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services billed under CPT codes 97811, 97813 and 97814 are granted; as so modified, the order is affirmed, without costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that it had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule. As to so much of the complaint as sought to recover upon claims for services billed under CPT codes 97810, 97811, 97813 and 97814, the Civil Court, by order entered December 17, 2014, limited the issues for trial, pursuant to CPLR 3212 (g), to the proper application of the fee schedule. Defendant appeals, as limited by its brief, from so much of the order as denied the branches of its cross motion seeking summary judgment [*2]dismissing so much of the complaint as sought to recover upon claims for services billed under CPT codes 97810, 97811, 97813 and 97814.
For the reasons stated in Z.M.S. & Y Acupuncture, P.C., as Assignee of Famojuro, Olajumoke v GEICO Gen. Ins. Co. (___ Misc 3d ___, 2017 NY Slip Op ______ [appeal No. 2015-398 K C], decided herewith), the order, insofar as appealed from, is modified by providing that the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services billed under CPT codes 97811, 97813 and 97814 are granted.
PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.
ENTER:
Paul Kenny
Chief Clerk
Decision Date: December 22, 2017
Legal questions
A question of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.
Did the insurer prove that the amount billed exceeded the applicable workers’ compensation fee schedule?
This decision: Excess shown for some charges, not for others
Held the insurer established full payment under the fee schedule for CPT codes 97811, 97813 and 97814 but left the 97810 charges for trial, where fee schedule application was the only issue.
Of the 284 decisions on this question in the Second Department courts and the Court of Appeals, 24 (this one included) are in the same category.
Similar decisions
- Z. M. S. & Y Acupuncture, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 51891(U))A fee-schedule defense is not subject to preclusion for services rendered after April 1, 2013, under 11 NYCRR 65-3.8 (g).
- Acupuncture Now, P.C. v GEICO Ins. Co. (2018 NY Slip Op 51647(U))The insurer's cross motion for summary judgment on the fee-schedule defense to claims billed under CPT codes 97810 and 97811 was granted on appeal.
- Oleg’s Acupuncture, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 51863(U))The insurer established full payment under the chiropractic acupuncture fee schedule for services billed under CPT codes 97813 and 97814.
- UGP Acupuncture, P.C. v GEICO Ins. Co. (2022 NY Slip Op 50609(U))The insurer's fee-schedule summary judgment on claims under CPT codes 97810 and 97811 was upheld on reargument and appeal.
- Live In Grace Acupuncture, P.C. v GEICO Gen. Ins. Co. (2020 NY Slip Op 51360(U))The insurer established full fee-schedule payment for acupuncture services billed under CPT codes 97813 and 97814.